Etiology-based strabismus classification scheme for pediatricians.

Background: Pediatricians are regularly involved in the initial examination of children presenting with strabismus, a common ocular condition occurring in 3% of children. The objective of this review was to gain insight into pediatric residents, fellows and attendings` understanding of strabismus, and to propose an etiology-based strabismus classification scheme to aid this understanding.

Methods: A survey was conducted in a single Department of Pediatrics in a university academic institution in order to assess the degree of understanding of the classification, etiology and nomenclature of strabismus.

Ocular features of Townes-Brocks syndrome.

Townes-Brocks syndrome (TBS) is a rare genetic syndrome associated with heterozygous mutations in SALL1 and characterized by abnormalities of the anus, ear, and thumb. Ophthalmic findings have been rarely reported and include congenital cataract, microphthalmia, optic nerve atrophy, coloboma, epibulbar dermoid, and dysinnervation patterns, such as Duane syndrome and gustatory lacrimation. We report a case of genetically confirmed TBS showing a spectrum of ocular anomalous innervations, including bilateral type 1 Duane syndrome and Möbius sequence, left-sided Marcus Gunn jaw winking, left eye gustatory lacrimation, and lack of emotional tearing bilaterally.

Evaluation of the underlying causes of papilledema in children.

Objective: The purpose of this retrospective study was to identify the types and relative frequencies of intracranial disorders in pediatric patients who present with papilledema.

Design: Retrospective case series.

Participants And Methods: This study was conducted in 2 pediatric ophthalmology clinics, both providing community-based care in a large inner-city urban center in the U.

MACULAR DETACHMENT ASSOCIATED WITH ANOMALOUS OPTIC NERVES AND DURAL ECTASIA IN 49, XXXXY SYNDROME.

Purpose: To present a case of a patient with XXXXY syndrome, anomalous optic nerves, and dural ectasia in conjunction with macular detachment.

Methods: Case report.

Results: A 3-year-old boy with XXXXY chromosomal abnormality presented with bilateral maculopathy.

Macular optical coherence tomography in patients with unilateral optic nerve hypoplasia.

Purpose: To characterize the extent and location of macular thinning in patients with unilateral optic nerve hypoplasia (ONH) as compared to the contralateral normal eye.

Methods: The medical records of patients with unilateral ONH who underwent spectral domain optical coherence tomography (SD-OCT) of the macula were retrospectively reviewed. SD-OCT scans were manually segmented by 3 observers in 3 macular regions (superior, central, inferior).

Peripheral nonperfusion and tractional retinal detachment associated with congenital optic nerve anomalies.

Purpose: To report an association of congenital optic nerve anomalies with peripheral retina nonperfusion and to describe the clinical manifestations and treatment.

Design: Retrospective, observational case series.

Participants: Fifteen patients with congenital optic nerve anomalies referred for pediatric retina consultation were studied.

Apnea and bradycardia in two premature infants during routine outpatient retinopathy of prematurity screening.

Two unrelated premature infants at risk for retinopathy of prematurity (ROP) were discharged home from a neonatal intensive care unit. Appropriately timed ROP examinations were performed in an outpatient setting in a free-standing pediatric ophthalmologist's private office remote from any hospital. The infants developed severe apnea and bradycardia at the end of the ROP examinations.

Ocular abnormalities in Floating-Harbor syndrome.

We present the first case report of a comprehensive eye examination in a patient with Floating-Harbor syndrome. Ocular findings were limited to partially accommodative, acquired esotropia, and unusual eyelashes. A variety of other ocular features have been previously reported in the nonophthalmic medical literature and are herein reviewed.

Oculomotor abnormalities in a patient with fragile X-associated tremor/ataxia syndrome.

We present a case report of an 80-year-old man with Fragile X-associated tremor/ataxia syndrome (FXTAS) and acquired diplopia, strabismus, and other oculomotor abnormalities. This is the first case report of ocular abnormalities in a patient with FXTAS.

Combined strabismus and lens surgery.

Background: Simultaneous eye muscle and lens surgery in patients with strabismus and lens abnormalities offers the advantage of avoiding staged surgery.

Methods: Thirty-three combined strabismus and lens surgeries were performed on 30 patients who ranged in age from 22 months to 91 years. Fifteen of the strabismus procedures were performed for esotropia, 12 for exotropia, 4 for vertical deviations, and 2 for combined vertical-horizontal deviations.

Medical imaging in pediatric neuro-ophthalmology.

This article provides an outline of the congenital and acquired conditions encountered in the practice of pediatric neuro-ophthalmology. Although some entities can be effectively evaluated clinically, CT and MR imaging studies may prove instrumental in many instances for detailed evaluation, narrowing of the differential diagnosis, or exclusion of underlying central nervous system pathologic findings.

High myopia associated with retinopathy of prematurity is primarily lenticular.

Purpose: To determine which of the eye's refractive components are responsible for the high myopia in retinopathy of prematurity (ROP), as compared with highly myopic eyes in full-term patients.

Methods: The study included 53 highly myopic eyes in 34 patients with a history of ROP, and 66 highly myopic eyes in 37 full-term patients. Measurements included refraction, keratometry, and A-scan values for axial length, lens thickness, lens position, anterior chamber depth, anterior segment depth, and lens power calculations.

The child's eye in systemic diseases.

This article briefly describes the ocular manifestations of pediatric systemic diseases and gives practical advice regarding the management of the ocular involvement by the primary health care provider.

The visually impaired child.

This article discusses the causes of childhood blindness and how the primary care provider may begin the appropriate steps toward diagnosing and managing the visually impaired child. Community resources (see Box 3) and low-vision programs in schools should be used so that parents do not need to reinvent strategies to raise a blind child. Worldwide, childhood blindness, which places is a tremendous burden on families and communities of the third world, is mostly preventable with improved hygiene, diet, and immunization.

Pediatric tumors of the eye and orbit.

Most ocular and orbital tumors of childhood are distinct from tumors that occur in adults. Many are congenital with early presentations. Most pediatric orbital tumors are benign; developmental cysts comprise half of orbital cases, with capillary hemangioma being the second most common orbital tumor.

Guidelines for pediatrician referrals to the ophthalmologist.

It is common in pediatric ophthalmology to see children with eye disorders that have gone undetected for years. Many conditions can progress slowly, are not painful, or are unilateral so as not to be bothersome to the child or noticeable to the parent or physician. Pediatricians often ask what they could have done to confirm the presence of the condition and whether the child should have been referred for specialty examination.

The eye examination in the pediatrician's office.

The visual system of children must be routinely examined by the pediatrician. Speed, skill and diagnostic abilities will increase quickly as the examination techniques described here are practiced on a daily basis. When parents recognize that the pediatrician is also concerned about their child's visual health and development, they will play a more active role in obtaining crucial family ocular history, note ocular changes that otherwise may be ignored, and, if indicated, participate in the referral and treatment process to avoid life-long visual consequences.

Anatomy, development, and physiology of the visual system.

This article serves to familiarize the reader with the normal anatomy, embryology, and physiology of the visual system. Other articles in this issue introduce examination techniques and the pathology of the eyes of pediatric patients.

The effectiveness of occluder contact lenses in improving occlusion compliance in patients that have failed traditional occlusion therapy.

Purpose: Management of infants and young children with dense amblyopia, including that which results from unilateral congenital cataracts, is challenging because of noncompliance with occlusion therapy. Occluder contact lenses (OCLs) have been described to successfully improve visual acuity in patients with amblyopia. The purpose of this study was to evaluate the effectiveness of OCLs in improving occlusion compliance in infants and young children with dense amblyopia who had failed traditional occlusion therapy.